Healthcare Provider Details

I. General information

NPI: 1083579148
Provider Name (Legal Business Name): STACY NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACY DUNKLAU LMT

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 E 6TH ST STE 116
FREMONT NE
68025-5092
US

IV. Provider business mailing address

6863 COUNTY ROAD 11
ARLINGTON NE
68002-5167
US

V. Phone/Fax

Practice location:
  • Phone: 402-720-1741
  • Fax: 402-769-4005
Mailing address:
  • Phone: 402-670-7491
  • Fax: 402-769-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14701
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: